- Highmark Health (Albany, NY)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims… more
- Northwell Health (New Hyde Park, NY)
- …responsible for the development, implementation, and maintenance of drug formularies, clinical utilization management ( UM ) criteria, and evidence-based drug ... findings. + Performs all duties of a licensed registered Pharmacist as required by the leadership and as identified...in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development… more